Because of the debt ceiling bill, may I introduce you to what could become our health care future with nationalized medicine? Stay with me here, this does apply to the US. Australia has nationalized medicine. That does not mean free, unless you have a concession (are on disability or welfare.) Non concession patients pay a large portion of the fee for most routine doctor’s visits. If you keep to the limited time alotted you pay usually $62 per visit. If you choose not to wait for the Medicare refund to come through the mail you take the receipt to a Medicare office, take a ticket, stand in line and get a refund of $23. That “free” doctor’s visit just cost you $39.00. If the visit goes over time you pay more. A mother thought the kindly Cottesloe doctor was concerned. He was concerned enough to charge her $80.00 for answering the extra questions he asked about her son when she went over the alotted time. She was not informed that this was their pratice until the bill was handed to her.

If you earn $60,000 per year you are taxed at a 48% income tax rate. That way your wealth is redistributed. You get ‘not free’ health care and you are taxed to pay for others to get ‘actually free’ health care. Less you think $60,000 is a good living the median price for a home in Perth is around $400,000, much higher than many places in the US. Food, clothing, gasoline and entertainment is about twice the cost of what it is in the US. You can only get variable interest rate mortgages, rates are high and seem to increase continually.

Going to one of the public hospitals for an emergency means you will not be charged. However you may be treated in a hallway and be entertained by drunken or very ill ‘others’. You may never actually be wheeled into a room. I am not exaggerating. This is an actual experience.

Doctors in Perth, Western Australia citing rising overhead costs and inadequate government remuneration are now charging patients $100 per year to register with them. If you register you are guaranteed an emergency visit on the day you call, and a routine visit within 5 days. One doctor in Subiaco, a ritzy suburb of million dollar+ homes near universities, hospitals and many doctor’s surgeries, says he is reducing his patient list this way. It’s natural selection. You don’t pay, you select yourself out naturally. The minister (politician overseeing the Health Dept) Dr. Kim Hames described the fees as “bizarre”. He predicts that doctors could face a backlash (how about a riot in the waiting room?) from patients if someone who was cranky from not feeling well and had been waiting a while had someone else "slotted in" ahead of them because the newcomer had paid the $100 registration fee, and the waiting one had not.

Health Consumers' Council executive officer Michele Kosky said it was another blow for patients on low incomes but it was clearly a way for GPs who were overwhelmed by demand to extract conditions from patients. What she did not say, but is true nonetheless, is that these fees will shake the concession (welfare and disabled patients) off the rolls. Concession patients do not pay a coshare and therefore are remunerated at a lower fee than non concession patients. Where will the concession patient go? To the doctor in a less well heeled suburb not charging the fee. How long will he survive in practice being swamped by low fee patients? Will the quality of care likely suffer? Will he be able to afford the equipment or qualified staff, even the cleaners? What about his exhaustion level, will it smother his passion for the field? Where will he go?

In an environment where general practitioners are few, the doctors use the fees to compensate themselves over the less than adequate Medicare remuneration schedules. Medicare fails to keep up with the cost of living, over head costs do not. With the lack of doctors they can cherry pick their patients according to their ability to pay. The doctors are exhausted. When the visits are subsidized the services are used more than they would be if they were not subsidized. The worried well fill the waiting rooms. In order to protect themselves from low government remuneration and higher surgery costs doctors have instituted these fees. $100 annual fee for each adult patient and $75 for each child adds up to an annual fee of $425 per family of 2 adults and 3 children.

The August 2011 new much hated/loved/applauded/decried debt ceiling drama contains some landmines. One of them is that if the gang of 12 lawmakers, known as the 'Dirty Dozen' takes the same path as the preceding 18 committees have and their negotiations stall one of the triggers is that automatic cuts will happen to Medicare. Not to the recipients but to the providers. Doctors and providers of services will have their already less than adequate remuneration slashed. Enter the Australian example. The doctors are paid less, they have to find a way to shake off the non payers or the patients who are compensated at a lower rate, to survive in business. Will they institute patient registrations? Wll the quality of care degrade? Will they flee their practices and open a florist store, less stress higher margins, no law suit over wrongful arranging?

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